New Jersey health insurance exchange / marketplace

More than a quarter of a million NJ enrollees in 2nd open enrollment; overall rate hike just 2%

How many people have enrolled?

254,316 people enrolled in the New Jersey exchange during the second open enrollment period, from November 15 to February 22, and 83 percent of them qualified for premium subsidies. The enrollment total includes 133,215 renewals from 2014, of which 75,712 were “active” renewals (as opposed to auto-renewals). Of the active renewals, 45,197 picked a new plan for 2015 rather than keeping their existing 2014 coverage for another year.

Another 60,757 New Jersey exchange enrollees were eligible for Medicaid or CHIP between November 15 and February 22.

Open enrollment for 2015 has ended, and this applies to plans purchased outside the exchange as well as plans within the exchange. There’s a special enrollment period from March 15 to April 30 for people who were unaware of the ACA’s penalty for being uninsured, but other than that, you can only purchase 2015 coverage if you have a qualifying event. And people who don’t have health insurance coverage in 2015 will face a much more significant penalty than they did last year: $325 per uninsured adult (half that amount for children under 18), or 2 percent of household income, whichever is greater.

Joel Cantor, director of the Rutgers Center for State Health Policy, had estimated that total private plan enrollment in the New Jersey exchange could reach 250,000 people by the end of the 2015 open enrollment period, and it turns out that his prediction was pretty spot-on.

Two new carriers brings exchange total to five

In 2014, only three carriers participated in the exchange in New Jersey: Horizon Blue Cross Blue Shield, AmeriHealth, and Health Republic of New Jersey. For 2015, two more carriers have joined them: UnitedHealthcare and Oscar Health Insurance.

Health Republic is a new consumer oriented and operated plan, or co-op, created under a provision of the ACA, and Oscar Health Insurance is an innovative new carrier that started in New York last year and is expanding to New Jersey.

What about premiums?

In the Newark area, the second-lowest-cost silver plan (the benchmark plan) could be less expensive in 2015 than it was in 2014. According to data from the Kaiser Family Foundation, the average in 2014 for a 40 year old non-smoker was $322 per month, and that’s dropped to $316 per month for 2015 (though in most areas, staying with the benchmark plan means switching carriers for 2015).

In Bergen County, the carriers offering the lowest-cost silver and bronze plans, as well as the second lowest-cost silver plan, are all different from the carriers that offered those plans in 2014 – highlighting the importance of shopping around during open enrollment.

The New York Times Upshot has an interactive map that further details the importance of shopping around during the 2015 open enrollment period. For New Jersey residents (Newark area) who had the benchmark plan in 2014 and opt to simply renew that same plan, the average rate increase for 2015 is roughly 11 percent. But people who shop around and switch to the new benchmark plan will see an average rate increase of just 2.2 percent.

And across all plans and metal levels in the exchange, an analysis from the Commonwealth Fund found an average 2015 premium increase of just 2 percent for a 40 year-old non-smoker.

The relatively low level of competition in 2014 – just three carriers in the exchange – is one of the reasons given for the higher-than-average premiums in New Jersey during the first open enrollment period. According to a report released by the U.S. Department of Health and Human Services (HHS), the average 2014 cost for a bronze plan —the lowest-cost option — in New Jersey was $332 in 2014, compared to a national average of $249 a month. But the entry of two new carriers has helped to hold down the average benchmark plan rates for 2015.

An HHS survey in mid-June found that New Jersey had the highest average after-subsidy cost for health insurance among the 36 states where HHS is running the exchange: $148 in New Jersey, compared with an average of $82 across all 36 states. This is indicative of not only higher unsubsidized premiums, but also higher average incomes in NJ, and perhaps an affinity for plans with higher metal levels. For people with the same income level (assuming they are subsidy-eligible), it doesn’t matter what state they live in or how expensive the unsubsidized premiums are — the subsidy amounts will differ, but the after subsidy premiums for silver plans will be the same, since the ACA sets net premiums as a percentage of income.

Switch to a state-run exchange pending SCOTUS decision?

New Jersey has a federally-run exchange, and Governor Christie has twice vetoed legislation that would have put the state on a path to creating its own exchange. But NJ Senator Nia Gill is introducing the legislation again, and the first meeting of the Senate Task Force on Health Exchange Implementation took place in early December.

Senator Gill and her colleagues are concerned that if the Supreme Court rules against subsidies in states with federally run exchanges, subsidies for tens of thousands (possibly two hundred thousand plus by then) of New Jersey residents could disappear in June. The Supreme Court is set to hear King v. Burwell in March, and a ruling is expected in June.

If the court rules that subsidies are only legal in state-run exchanges, it would be essential that NJ be able to enact its own exchange, which is where Gill’s legislation comes in. But it would still have to be approved by Gov. Christie. Experts agree that Christie is unlikely to simply let up to two hundred thousand residents lose their coverage (which is a possible outcome if all of them were to lose their subsidies), although it’s unclear what solutions would be used if SCOTUS rules that the subsidies in HHS-run exchanges are illegal.

Targeted outreach and more experienced navigators

Navigator organizations in New Jersey have more data and experience in the second open enrollment period than they did a year ago. They have zip code based information in terms of where people have enrolled and where there are still large pockets of eligible people, so they can better target their outreach.

Get Enrolled America’s New Jersey branch learned last year that recurring enrollment events work better than one-time events, and also that people are more likely to enroll after being contacted at least four times. They’re incorporating that information in their enrollment strategies for 2015.

2014 enrollment data

For the 2014 open enrollment period, by April 19, 161,775 people had completed their enrollment in private plans through the New Jersey exchange. Private plan Obamacare enrollments in the New Jersey exchange were nearly 70 percent higher than HHS had predicted last year, prior to open enrollment (the projection was about 113,000 people in 2014). Every state saw a surge in enrollment in March and early April, but New Jersey’s was the seventh largest surge in the country.

The carriers in New Jersey have been forthcoming with their enrollment numbers though. AmeriHealth had 130,000 enrollees as of early September (up from about 10,000 at the end of 2013), and Horizon BCBS had 140,000 by mid-August. Health Republic had enrolled roughly 4,000 new members. These totals are for the carriers’ full book of business, including both on and off-exchange enrollments. But AmeriHealth reported that the majority of their new enrollments have been through the exchange.

More health plans on the horizon?

In mid-October, two NJ hospital systems – Hackensack University Health Network and Meridian Health – signed preliminary paperwork to begin a merger process, although the deal still has to be approved by regulators. If approved, Hackensack Meridian Health would become the largest hospital system in NJ, and would include nine acute-care hospitals, two children’s hospitals, and numerous doctor’s offices, rehab centers, skilled nursing facilities, and assisted living centers.

Officials are predicting that if it goes forward, the merger will lead to the creation of new provider-managed health insurance plans, which could bring more competition to the NJ health insurance market.

ACA’s impact on the uninsured rate

In addition to the people who have purchased private plans through the exchange, another 343,000 people had enrolled in New Jersey’s expanded Medicaid by mid-October. That means about 74 percent of the total Medicaid-eligible population in the state enrolled in the first year expanded Medicaid became available (Medicaid enrollment continues year-round). From December 2013 through October 2014, total Medicaid enrollment in New Jersey grew from 1.28 million to 1.65 million people.

In September 2013, New Jersey’s uninsured rate was 21.2 percent. By June 2014, that rate had dropped to 11.5 percent, according to a study by the Robert Wood Johnson Foundation. In less than a year, the ACA has halved the uninsured rate in New Jersey.

Congressional outreach and legislation

In late February, 11 New Jersey lawmakers — all Democrats — partnered with Get Covered America to volunteer their time in helping NJ residents get enrolled in the exchange. The lawmakers’ staff members also helped with the enrollment effort, which was Get Covered America’s largest partnership with state lawmakers in the country. Their involvement was part of the reason for the extremely successful final couple of months of open enrollment in New Jersey.

In mid-January, U.S. Rep Bill Pascrell (D, NJ) introduced a bill that would allow HHS to recoup ACA outreach funding that remains unused by Republican governors like Chris Christie who have refused to use the money in their states to promote the ACA and educate residents about its benefits. New Jersey officials were involved in lengthy discussions with HHS over the use of $7.67 million in federal funds that had been granted to NJ in 2012 to use for promoting the state’s health insurance exchange.

The money was intended for outreach, advertising and general promotion of the ACA and the exchange, although NJ officials wanted to use it to staff a call center for the state’s expanded Medicaid program. But HHS had made it clear last year that such a use was not permitted.

Ultimately, the state and HHS were not able to come to a compromise on the issue. New Jersey forfeited the money on February 20 when the deadline passed, and HHS officially rescinded the funds in early May.

History of the New Jersey exchange

The New Jersey Assembly passed two bills authorizing a state-run exchange in 2012, but both were vetoed by Gov. Christie. Those vetoes left the federal government to operate the health insurance marketplace in New Jersey. Governor Christie has taken a very hands-off approach to the ACA, and the state has done little to promote the HHS-run exchange, leaving most of the heavy lifting to brokers, navigators and HHS.

The state did opt to expand Medicaid however, making health insurance available to hundreds of thousands of low-income residents.